RN Utilization Review jobs in California

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Clinical Appeals/Audit Specialist
Loma Linda University Medical Center - Murrieta - Murrieta, CA
Minimum of three years experience in case management or discharge planning, utilization review, or internal auditing required....
Utilization Review Case Manager - FT/PT
Healthcare - Del Mar, CA
Part/Full time Utilization Review Coordinator to communicate substance abuse and mental health clinical information to managed care/insurance companies and...
Easily apply
BH Care Manager I,ll,ll - LCSW, LMFT, RN - San Diego / Thous...
Anthem, Inc. 674 reviews - San Diego, CA
Current unrestricted license from the State of California as an LCSW, LMFT, RN required. Responsible for managing psychiatric and substance abuse or substance...

Registered Nurse Case Manager

San Bernardino County 50 reviews - Colton, CA
$67,350 - $96,158 a year
Experience in Case Management, Managed Care or Utilization Review is highly desired. One (1) year of experience as a registered nurse in Case Management,...

Utilization Review Nurse

Medix 45 reviews - Los Angeles, CA  +2 locations
In need of a “Case Manager" to handle Utilization Review. It is critical that this person has experience in Utilization Review, CPT Coding, and knowledge of...

Senior Nurse Reviewer, Utilization - Remote U.S. based

Mitchell International, Inc. 2 reviews - California
Reviews requested treatment/procedures within Mitchell utilization review policies, URAC time frames or state-mandated timeframes (whichever is more restrictive...

Manager Utilization Management

Kaiser Permanente 2,827 reviews - Vallejo, CA  +1 location
Current California RN licensure. Manages projects related to chart reviews. Kaiser Permanente conducts compensation reviews of positions on a routine basis....

Clinical Appeals RN - Telecommute

UnitedHealth Group 2,445 reviews - Cypress, CA
Perform Pre-service utilization and concurrent reviews using Milliman criteria for Standard and Expedited Medicare member appeals in a fast-paced environment....

Care Coordinator

HealthCare Partners 110 reviews - Costa Mesa, CA 92626
Medical review as appropriate. Collects and prepares medical records for review. Review of requested services according to established guidelines and....

Manager Utilization Management - Sacramento, CA

UnitedHealth Group 2,445 reviews - Sacramento, CA 95828
RN, Registered Nurse, UR, UM, Utilization Review, Utilization Management, Concurrent Review, Milliman, Interqual, Managed Care, Insurance, Case Management, Case...

Continuing Care Utilization Review Coordinator, RN

Kaiser Permanente 2,827 reviews - San Jose, CA  +4 locations
Reviews utilization patterns, identifies trends and problems areas for special studies. Conducts utilization review for in-house patients and/or those members...

Inpatient Utilization Management Nurse

San Francisco Health Plan 7 reviews - San Francisco, CA
Prior experience in case management, resource management or utilization review preferred. San Francisco Health Plan is seeking a California Registered Nurse for...

Utilization Review Nurse

A New Start Treatment and Recovery Center 16 reviews - Los Angeles, CA 90034
Utilization review experience preferred but will train right candidate:. Complete all insurance and review documentation in timely manner....
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Interim Care Management Nurse Consultant
Clinical Management Consultants - San Rafael, CA
$139,057 - $151,672 a year
The Interim Consultant will oversee the functions associated with care facilitation, utilization review, and social work as well as the movement of patients...
Clinical Appeals Coordinator
Sharp Healthcare 94 reviews - San Diego, CA
70443, Clinical Appeals Coordinator, Case Manager, RN Case Management, Utilization Review, Denial Management, Appeals, Audits, Quality, CCM, ACM, CPHQ, CPHM....

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Company with RN Utilization Review jobs
As part of Loma Linda University Medical Center, we celebrate the healing ministry of Jesus Christ -- to make man whole.